Revenue lift · FQHC & community health
Revenue lift · FQHC & community healthPPS encounter capture lift produced $920K in additional grant-protected revenue.
A 3-site federally-qualified health center in rural North Carolina was leaving PPS encounter rate revenue on the table due to documentation and billing-cycle mismatches. Medonix rebuilt the encounter-capture workflow and recovered $920K in year-one revenue, plus established sustainable wraparound payment reconciliation.
- FQHC & community health · Primary care + behavioral
- Client: 3-site FQHC
- State: NC
- Revenue lift
Outcome at a glance
Before and after, on the metrics that mattered.
Wraparound reconciliation
PPS recovery, year 1
Days in A/R
The situation
Where the practice was when Medonix engaged.
A 3-site federally-qualified health center serving rural North Carolina was billing standard fee-for-service against North Carolina Medicaid managed-care plans without consistently applying PPS encounter rate logic. The CFO had identified the issue but did not have the internal resources to rebuild the workflow.
Wraparound payment reconciliation against North Carolina Medicaid was running months behind, with several payments unaccounted for and others applied incorrectly. The behavioral-health encounters at one of the three sites were not being properly bundled with same-day medical encounters per PPS rules.
The FQHC executive director and CFO selected Medonix on the basis of the FQHC playbook depth, specifically the PPS encounter-rate calculation per state and the wraparound payment reconciliation workflow.
The work
What Medonix actually did.
Discovery audited 12 months of PPS encounter billing across the three sites and identified $920K in recoverable revenue from underbilled encounters and missed wraparound payments. The recovery scope included resubmissions where timely filing still permitted, plus appeals on managed-care wraparound payment shortfalls.
Medonix rebuilt the PPS encounter capture workflow with automated encounter-rate calculation per service category, same-day encounter bundling logic for behavioral and medical visits, and a monthly wraparound payment reconciliation against North Carolina Medicaid managed-care remits.
The 340B program coordination workflow was added to the engagement in month four, with split-billing tracking and OPAIS audit support.
The outcome
Where the practice landed.
Year-one PPS recovery totaled $920K, all of it grant-protected revenue that was reinvested into clinical capacity at the three sites. Wraparound payment reconciliation reached current state by month three and has stayed current since.
Days in A/R compressed from 47 to 23 over the year. The behavioral-health encounter bundling fix alone added an estimated $180K in annualized run-rate revenue going forward.
The FQHC has since referred two peer FQHC organizations in the same HRSA region to Medonix.
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